Shannon Kauffman, MD Speaks About Nanoknife Video Transcript

Nanoknife is a procedure where we can insert probes into the body using imaging guidance, so CT scan, or ultrasound guidance. Insert probes into tumors and once we get those probes positioned within the tumors the advantage of the nanoknife is that it uses electricity, so we electrocute the tumor and that opens up little tiny holes in the cells of the tumor cells. Those cells then leak out, their contents leak out, and they undergo natural cell death. The advantage of the nanoknife over other technologies such as radio frequency ablation which uses heat or cryo-ablation which uses freezing, is that you can use this to kill the tumor, but it leaves the structure, the surrounding structures intact. So it leaves the proteins untouched and it leaves whatever structure you're in or near untouched. You can ablate with, you can get rid of tissue next to blood vessels, you can be near bile ducts, you can be next to colon or small bowel, and it leaves those structures untouched, whereas it will still go in and kill the tumor itself.  So it's very precise, it has to be, the needles have to be 1.5 to 2 cm apart and you can put a variety of needles anywhere from 2 to 7 needles in place, or more than that.  And shape, if a tumor is abnormally shaped, you can shape your zone, killing zone, around to whatever the tumor shape is.  But we can be right next to the aorta, right next to big blood vessels, and those blood vessels will continue to work.  They heal themselves, there's no injury to the blood vessels themselves because that structure is left behind.

So here at Miami Valley, we were the first to bring this to town. And we've certainly got the most experience in doing this, we've been doing this for a number of years now and have seen a large number of patients and that experience I think is vitally important for this because it is a very meticulous process to be able to go through the arterial supply and the anatomy that you see, is different in almost every patient. And to be able to recognize those variants, it's certainly a procedure that requires a lot of experience to do.

So, the nanoknife is very new. And the patients that are referred to us that we consider using the nanoknife on are patients who don't necessarily have another option. If they have a tumor that's right next to a very large blood vessel, something that we can't use radiofrequency ablation on, we can't use cryo-ablation on, and they're not a surgical candidate, then we can consider using a nanoknife because it leaves those blood vessels or large bile ducts, or bowel intact.  Or if it's next to the ureator or something along those lines, those are all structures that you can't heat up, and/or freeze, because you'll destroy those tissues as well. The advantages of the nanoknife is that it kills cells but leaves that structure in place. So you can be right next to those structures, you can ablate across a blood vessel, and that blood vessel will continue flowing. If you've got a tumor that comes right up and wraps around a blood vessel, you can ablate on either side of that, you can use the nanoknife to kill the tissue on either side of that, but the blood vessel will be uninjured. So those are the patients we use this in, those patients who don't have another option or it's right next to critical structure that we can't find another technology for.

We've used it on a variety of things.  We've used it on sarcomas.  We've used it on . . . in endometrial cancer treatment. You can use it on any type of cancer. It will kill cells no matter where it's at. So it's just a matter of getting the probes, if you can get into the correct location with the probes. So, benefits of the nanoknife are a wide variety of things. One, these are patients who don't have another option. They have no other options for treatment, it's not surgically accessible, they're not a surgical candidate, it's next to structures that can't be safely treated with radiofrequency ablation or cryoablation, so that's the biggest advantage. The other advantage is that it's a minimally invasive procedure. There are small incisions that we make that we don't even have to put a stitch on. We can have a Band-Aid placed on afterwards. We will typically keep their patients in overnight, just for any pain control if they are having any pain. We have not had anybody that's had any significant pain with this procedure. But it's also to watch them to make sure they're not having any complications afterwards. Typically patients are sent home the next day. The procedures performed under general anesthesia. So once we put them under they wake up and it's all over with. So there's no significant pain or anything like that with it. Very minimally invasive. We can go back in and do it again if need be, or if another tumor pops up somewhere else that is inaccessible or judged to be a candidate for it, then we can certainly go back. There's no limitation on the number of times you can do it. It's a very time intensive procedure. It has to be very precise to be able to do this, and we have to have high-quality imaging to be able to do this. We typically do this with a CT scans to place our needles and to get the needles in the correct locations and then we have to use this data to make a 3-D image to be able to measure how far the distance is between the probes. Then we input that information into the computer and we can then shape our ablation field to be able to do that. So, nanoknife is here at the region's leader, Miami Valley. It’s the only place in town that has it. We were, I think, the first center in the state of Ohio to have it. There's no one else in town that has this ability to be able to do this -- to remove these tumors that are otherwise inaccessible.